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目的探讨原因不明复发性流产(URSA)患者和正常妊娠妇女蜕膜活化和抑制分子的变化。方法2003年3月至2005年2月采用实时定量逆转录-聚合酶链反应(RT-PCR)检测上海仁济医院25例URSA患者与32例正常妊娠妇女蜕膜组织CTLA-4、GITR、CD69、CD40L、OX40 mRNA的表达。结果URSA患者蜕膜组织CD69、CD40L、OX40 mRNA的表达较正常妊娠患者显著升高,CTLA-4、GITR mRNA的表达显著降低。结论UR-SA患者蜕膜局部的免疫环境失调,活化分子表达增强、抑制因子表达下调,可能影响了CD4+CD25+调节性T细胞的分化,导致母胎耐受形成障碍,介导了URSA的发生。
Objective To investigate the changes of decidual activation and cytokines in unexplained recurrent spontaneous abortion (URSA) and normal pregnant women. Methods From March 2003 to February 2005, CTLA-4, GITR, CD69 expression in 25 patients with URSA in Shanghai Renji Hospital and 32 normal pregnant women were detected by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR) , CD40L, OX40 mRNA expression. Results The expression of CD69, CD40L and OX40 mRNA in decidual tissue of patients with URSA was significantly higher than that of normal pregnancy, and the expression of CTLA-4 and GITR mRNA was significantly decreased. Conclusions Immune environment in decidua of UR-SA patients is imbalanced, the expression of activated molecules is enhanced and the expression of inhibitory factor is down-regulated, which may affect the differentiation of CD4 + CD25 + regulatory T cells and cause the formation of maternal-fetal tolerance and mediate the occurrence of URSA.